VACCINE TREATMENT OF TUBERCULOSIS 213 



expecting a great deal, in the absence of any more delicate indicator 

 to what is going on in the offensive-defensive interaction in the body, 

 than coarse clinical symptoms, to predict what will happen in a given 

 case and whether we are doing the best that can be done. 1 



While I have pointed out in the foregoing pages that we are not 

 yet in a position where we can speak definitely of the results of 

 vaccine treatment and its indications or centra-indications, I must 

 modify this statement somewhat, so far as tuberculosis is concerned, 

 and it may not be out of place to consider this special question by 

 itself and in some detail. 



VACCINE TREATMENT OF TUBERCULOSIS. 



The earliest attempts to influence the course of tuberculosis through 

 active immunization were made by R. Koch, and were based upon 

 the observation that a tubercular guinea-pig reacts quite differ- 

 ently to a subsequent inoculation with tubercle bacilli than does 

 a normal animal. For whereas in the latter a tubercular ulcer 

 develops at the site of the injection which does not heal, but per- 

 sists until the animal dies, local recovery occurs in the tubercular 

 guinea-pig without involvement of the regional lymph glands. 

 Evidently then the first inoculation, even though it leads to the 

 death of the animal, produces a certain degree of resistance which 

 the untreated animal does not possess, and it very naturally occurred 

 to Koch that it might be possible to utilize this observation as a basis 

 for the treatment of human tuberculosis. Further indications for 

 experiments in this direction were afforded by the finding, that, 

 whereas the injection of large numbers of tubercle bacilli hastens 

 the death of the tubercular animal, small doses, frequently repeated, 

 seemingly have a beneficial influence both upon its general condition 

 and upon the progress of the lesion at the site of the primary inocu- 

 lation. Since killed-off cultures, however, though quite efficacious, 

 were "apparently not resorbed from the point of inoculation, nor 

 otherwise removed, but remained there undisturbed and produced 

 abscesses," Koch attempted so to modify his vaccine as to separate 



1 The statement made by certain commercial houses that recoveries have 

 resulted following the use of bacterial vaccine in 80 per cent, of the cases is an 

 absurdity and will serve to discredit the entire question of vaccinotherapy both 

 with the laity and the profession. 



